Nominee Form Family Nominee Form The Christmas in Berthoud Team cannot guarantee Christmas gifts to all who request them. All nominees will be considered on the basis of need and funds available. Please Note: You must contact the family and be sure they are willing to receive the gifts prior to submitting this form. If CIB is unable to accommodate the request, we will contact them. Families will be contacted prior to delivery. Both Nominee and Nominator information will be kept confidential. Date Nominee Name* First Last Nominee Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Nominee Phone*Number of Adults*Please enter a value between 0 and 25.Number of Children*Please enter a value between 0 and 6.Child Name, Sex and AgeChild Name, Sex and AgeChild Name, Sex, and AgeChild Name, Sex and AgeChild Name, Sex and AgeChild Name, Sex and AgeWhat is the Family's Situation*Submitter's Name* First Last Submitter's Email Address* Submitter's PhoneCaptcha
